Provider Demographics
NPI:1972511012
Name:KITTRICK, BRUCE HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:HOWARD
Last Name:KITTRICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 993456
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96099
Mailing Address - Country:US
Mailing Address - Phone:530-244-3155
Mailing Address - Fax:530-243-5965
Practice Address - Street 1:SHASTA REGIONAL MEDICAL CENTER
Practice Address - Street 2:1000 BUTTE ST
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001
Practice Address - Country:US
Practice Address - Phone:530-244-5400
Practice Address - Fax:530-243-5965
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66403207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG664030OtherMEDICAL LICENSE
CA110158746OtherRAILROAD MEDICARE NUMBER